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WASHINGTON - Women who work for religious-affiliated organizations can have contraceptive services under their health insurance through separate coverage while allowing their employers not to violate their religious beliefs by exempting them from paying for it, according to a proposed regulation issued Friday by the Department of Health and Human Services.

Last August, when the government announced that insurance plans must cover women's contraceptive services with no co-pays under the 2010 health care law, some employers - charities, religious schools and hospitals - took issue with being forced to provide a service that goes against their beliefs.

"Today, the administration is taking the next step in providing women across the nation with coverage of recommended preventive care at no cost, while respecting religious concerns," said HHS Secretary Kathleen Sebelius in a press statement. "We will continue to work with faith-based organizations, women's organizations, insurers and others to achieve these goals."

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Under the proposed rule, religious organizations would inform their insurer of their exemption, and then the insurer would inform the organization's employees that the insurer would provide them with no-cost contraceptive coverage through a separate insurance policy not connected to the religious employer.

The insurer would be reimbursed through a reduction in the user fees it would normally pay to participate in the new state health exchanges, or marketplaces. The state marketplaces are websites where consumers can choose from eligible health insurance plans by comparing prices and benefits.

Chiquita Brooks-LaSure, a deputy director of policy and regulation for insurance oversight at HHS, said99% of women use contraception at some point, and the Institute of Medicine recommended contraception as a covered benefit because it would ultimately keep costs down for the public and private health care systems.

"Prevention saves dollars," she said. "The issuer provides coverage knowing that overall costs will not increase."

As it stands, 28 states already require insurers to cover contraception.

Anti-abortion groups immediately took issue with the proposed rule, while women's groups and equality organizations praised it.

"Our overriding concern is that women have meaningful access to essential preventive health care services, like birth control, without co-pays or deductibles," said Marcia Greenberger, co-president of the National Women's Law Center, which promotes equality for women, in a statement. "We look forward to reviewing and commenting on the proposed regulation in detail to ensure that women are able to make personal health decisions without interference by their bosses."

The American Civil Liberties Union, a non-profit that fights for individual rights, said the rule shows the administration wants to ensure women have "basic health services."

"Over the last year, we've seen a disturbing number of instances where employers are trying to impose their religious beliefs on a diverse workforce that does not share them, and opponents of the law have made it clear that they won't rest until no insurance plan, whatever the source, is required to cover contraception," said Sarah Lipton-Lubet, ACLU policy counsel, in a statement.

Alliance Defending Freedom, a conservative Christian group that advocates prayers at public meetings and crosses on public land, called the rule an "abortion pill mandate."

"The administration's narrow gesture does nothing to protect many faith-based employers or religious families from the unconstitutional abortion pill mandate," said senior legal counsel Matt Bowman. "The government has no business putting religious freedom on the negotiating table, or picking and choosing who is allowed to exercise faith."

Bowman refers to the "morning-after pill," or Plan B, available as an over-the-counter pill for adult women that prevents pregnancy up to three days after unprotected sex, or Ella, a prescription-only pill that prevents pregnancy up to five days after unprotected sex.

About 100 plaintiffs have filed 43 lawsuits against HHS nationwide, saying they believe the requirement violates the rights of religious organizations.

Priests for Life, a Roman-Catholic anti-abortion group that also objects to contraceptives, said the rule requiring contraceptive care should be rescinded completely.

But Thomas Reese, a Jesuit priest who is a senior fellow at the Woodstock Theological Center at Georgetown University, said he sees it as a "win-win" for both religious organizations and the government.

"I think they really worked hard to find a solution to take care of the problem that Catholic hospitals had with the rule," he said. "Congress made clear that it did not want abortion covered by federal funds."

He said he would leave the debate over whether the morning-after pill qualifies as an "abortion" to medical specialists.

"I think this should make both the bishops and the hospitals happy," he said, "and at the same time, it keeps employees happy."

The proposed rule is here:www.ofr.gov/inspection.aspx

Contributing: Cathy Grossman

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